Page 1 - Century Campaign Pledge Agreement

Campaign Pledge Agreement

I, _________________________________________________, accept the invitation to join my brothers in support of our fraternity in its mission
of building better men, better lives. I hereby do pledge and agree to contribute the sum of $______________________ as part of the Century
Campaign of the Alpha Gamma Alumni Chapter of Delta Sigma Phi to build a new Chapter house. My gift will be paid in the following manner:

m One-time payment } Plan to be paid over
m Quarterly (Jan/Apr/Jul/Oct)
m Semi-annually ________________
m Annually years
m Stock (publicly traded)

m Other: [Maximum 5 Years]

m I am affiliated with a company that has a matching gift program. Employer: ________________________________________

Start Date (please circle one): January April July October 20 _______________________________________

Signature: __________________________________________________________________ Date: __________________________________

Print Name: _________________________________________________________________ InitiationYear: _______________________________

Preferred Address: ________________________________________________________________________________________________

City: _______________________________________________________________ State: ___________________ Zip: _____________________

Home Phone: ____________________________________________ Work Phone: ____________________________________________

Cell Phone: ________________________________________________ E-mail: _________________________________________________

Gift to be made: m In my name as printed above

m In honor of: ________________________________________________________

m In memory of: ______________________________________________________

Payment Method: m Stock (publicly traded)
m Check

m Credit Card: ____ Visa ____ MasterCard ____ American Express ____ Discover

Credit card payments will be automatically deducted according to the payment schedule below. Please select one:
m monthly m quarterly m semi-annually m annually

Account No.: Exp. Date:

Signature:

NOTE: Pledges $25,000 and greater may be 100% tax deductible. Pledges $15,000 - $24,999 may be 50% tax deductible. Pledges
$14,999 or less will be directed to the Alpha Gamma Alumni Chapter of Delta Sigma Phi and are not tax deductible.
Note: Tax Deductible payments should be made payable to “Delta Sigma Phi Foundation” and include “Alpha Gamma Century Campaign” in the memo line.
† Contributions to the Delta Sigma Phi Foundation are tax deductible to the extent allowable by law and will be utilized to support educational

areas of the facility. Please consult with your tax adviser for more information.
Note: Non Deductible payments made directly to the ACB should be made payable to “Delta Sigma Phi.”
† Contributions to the ACB are not deductible as charitable contributions for federal income tax purposes. Gifts or pledges other than cash are subject to the

acceptance of the ACB.

If your pledge is eligible for tax deductibility, please indicate what portion of the amount you would like to receive such treatment:
$______________________. Please consult your attorney, CPA, and/or certified financial advisor for professional advice regarding this pledge.

Please send this Pledge Agreement to: For further information, please contact: Please scan code to go to the
Century Campaign William Toothaker, Account Manager online pledge form
The Campaign for Alpha Gamma of Delta Sigma Phi T: 770-903-3987 F: 770-903-3988
Campaign Headquarters E: WToothaker@elevateims.com
P.O. Box 80828 | Atlanta, GA 30366-0828